Provider Demographics
NPI:1104118611
Name:DOUHAN, PAUL (LICSW, CSOTP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DOUHAN
Suffix:
Gender:M
Credentials:LICSW, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N 1ST ST
Mailing Address - Street 2:SUITE 46
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 N 1ST ST
Practice Address - Street 2:SUITE 46
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2859
Practice Address - Country:US
Practice Address - Phone:360-336-2626
Practice Address - Fax:360-630-2034
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000055401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical